MEDICARE: DR. ROBERT IRA SACK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD438306	PA

General Provider Information

NPI Number	:	1124148721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT IRA SACK M.D.

Provider Business Mailing Address
First Line	:	5410 AVENUE SIMONE
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33558-2828
Country	:	US
Telephone Number	:	301-442-4158
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 N PRINCE ST
Second Line	:	T W PONESSA AND ASSOCIATES
City	:	LANCASTER
State	:	PA
Zip	:	17603-3010
Country	:	US
Telephone Number	:	717-560-7917
Fax Number	:	717-560-6452

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/09/2016

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